A high CBD cannabis strain has been called "Charlottes Web" after a young girl named Charlotte Figi was treated successfully for her Dravet Syndrome. But can CBD oil really help children and adults with autism? Some states allow doctors to use their clinical discretion to prescribe CBD to their autistic patients. Some parents have sought out CBD separately to treat other. Unfortunately, there is no cure for autism, but CBD has recently provided hope in other parents who seek comfort and a better quality of life for their children. As soon as it arrives, the cannabidiol interacts with specific.
Special With CBD Parents Oil Children Children Treat for - CBD Needs
The oil, which is not physically addictive, is typically taken as a liquid under the tongue, via gel capsule, or as a cream. It can also be mixed with food. CBD is thought to work on something in the body called the endocannabinoid system, which is involved in maintaining homeostasis, or balance. There are receptors for this system in many parts of the body, including the brain, which is why it's believed to help a host of different conditions.
The most research done on CBD is for its use with seizure disorders like epilepsy. For other conditions, the evidence is largely anecdotal. She works with many clients who have seen positive results with CBD oil but cautions that it "doesn't work for every person every time. If you're wondering whether it could help your child, find someone knowledgeable to consult. Finding a "cannabis consultant" such as Bissex is also an option for figuring out the right dosing, which varies for each person.
The most common negative side effects of CBD are drowsiness and dry mouth, but these often go away after a couple of weeks. Keep in mind that CBD oil can be pricey because of the cost in growing the plants and extracting the oil. Bissex recommends choosing products that have been independently tested, so you're sure they contain the amount of CBD they claim. Lowry, who says she personally can't recommend CBD because there is no safety or efficacy data on it yet, suggests finding out how much THC if any the product contains before giving it to a child.
As for whether CBD is legal, that's still a bit fuzzy. Other states have legalized recreational marijuana: Some states allow CBD oil as long as it's derived from hemp, but not from marijuana.
Interpatient variability may affect which blood concentrations will be effective, and tolerance is known to occur owing to downregulation of CB1 receptors. The debate about the use of cannabinoid products in pediatric patients has persisted owing to the lack of well-developed and published randomized controlled trials. There has been a wide variety of mostly case series and international studies for adult indications, such as chronic pain, MS, headache, and various neuropsychiatric disorders, which are beyond the scope of this review but have been reviewed elsewhere.
This has resulted in retrospective and parentally reported data in epilepsy and behavioral conditions. Despite the overall lack of published data on CBD in pediatric patients, most of the literature is devoted to its use in epilepsy.
Current large prospective trials are underway for different epilepsy indications, and recent animal studies researching use in perinatal brain injury and neuroblastoma may open new avenues to consider cannabinoids for pediatrics.
A Cochrane review 23 was conducted in to assess the safety and efficacy of cannabinoid use in patients with epilepsy. The authors included blinded and unblinded randomized controlled trials. Only 4 studies met their criteria, including 1 abstract and 1 letter to the editor Table 3.
All 4 trials were of low quality with small sample sizes and variations in product, dose, frequency, and duration. The only reasonable conclusion made was that the efficacy of CBD use could not be confirmed, but the rate of adverse reactions in each of the studies was low over a short period.
Included Studies in Cochrane Review The American Academy of Neurology conducted a systematic review in which included 34 studies that used medical marijuana to treat MS, epilepsy, and movement disorders. Despite this, parents and patients are making the decision to use these products for 3 reasons according to Cilio et al: It is important to note that the following studies are based on parental perceptions and thus we cannot draw definitive conclusions.
She suffered from frequent status epilepticus. Charlotte failed multiple medications, and at 5 years of age, she had significant cognitive delay and required help with all of her activities of daily living. Stories like Charlotte's have prompted parents across the country in similar situations to move their families across the country to gain access to these products.
Investigators at Stanford University administered a survey to parents on Facebook to identify parentally reported effects of CBD on their child's seizures. Twelve of these 19 patients were also able to be weaned from another antiepileptic drug. In addition, parents reported overall better mood, increased alertness, and better sleep. Parents reported oral CBD dosages of 0. As with previous surveys, dosage and formulations were varied but based on parental report of formulation used. Overall, most parents As mentioned above, these surveys should be evaluated carefully given the inability to verify dose, formulation, and response.
The conclusion that can be made is that there is a rather strong positive parental perception regarding the efficacy of cannabinoids, specifically CBD. Most orphan drug designations for CBD are for pediatric seizure disorders Table 4. Published findings from open-label use of CBD for treatment-resistant epilepsy under an expanded-access program at 11 epilepsy centers in the United States suggest that CBD might reduce seizure frequency and might have an adequate safety profile in children and young adults with this condition.
After announcing positive results from 2 pivotal randomized, double-blind, Phase 3 trials for the treatment of seizures related to LGS, and a third for seizures associated with Dravet syndrome in , GW Pharmaceuticals expects to submit a single New Drug Application for both indications to the FDA in the first half of for its proprietary pharmaceutical-grade CBD product Epidiolex.
Cannabinoids and CBD use in this patient population is a growing interest on social media sites. While the data for these indications are limited to case reports using dronabinol, some of the benefits of CBD on behavior and motor skills reported in the aforementioned retrospective studies in epilepsy may be transferable to this population as well. A 6-year-old patient with early infant autism received enteral dronabinol drops titrated up to 3.
He had improvements in hyperactivity, irritability, lethargy, stereotype, and speech. The dronabinol dose ranged from 2. Seven of the 10 patients had significant improvement in their self-injurious behavior that lasted through the follow-up at 6 months. Two of the 10 patients experienced agitation and the drug was discontinued.
Perinatal brain injury can be induced by neonatal asphyxia, stroke-induced focal ischemia, and neonatal hypoxia-ischemic encephalopathy, among other things. These conditions lead to long-lasting functional impairment due to neuroinflammation, apoptotic-necrotic cell death, and brain lesions. The endocannabinoid system responds early to neuronal damage, working to prevent glutamate excitotoxicity and regulate the inflammatory response.
While there are no current human studies, results from mice and pig models demonstrate that CBD can reduce the density of necrotic neurons and modulate cytokine release. Most recently, researchers have reported on the use of CBD in both in vitro and in vivo animal studies of neuroblastoma NBL , a common childhood cancer.
Worldwide, marijuana is the most commonly abused illegal substance and adolescent daily use is on the rise.
Unfortunately, the neurocognitive and behavioral effects of marijuana use in pediatric patients, including its effects on psychological dysfunction, amotivation syndrome, and carcinogenic risk, have been widely reported.
Evolving legislation and the increased use of cannabinoid products outside of investigational studies have also impacted our health care delivery and emergency resources. The state of Colorado has been on the forefront of the medicinal and recreational use of cannabis debate. Wang et al 48 reported the occurrences of pediatric emergency department visits associated with marijuana exposure before and after changes in drug enforcement in A total of patients younger than 12 years were evaluated for unintentional ingestions from January 1, , to December 31, Patients ranged in age from 8 months to 12 years and presented with symptoms of lethargy, ataxia, and respiratory insufficiency.
While the dosages were not reported, 7 patients ingested a marijuana edible. Eight of the 14 patients were admitted to the hospital with 2 admissions to the pediatric intensive care unit. Prior to diagnosis, these 14 patients received routine testing such as urinalyses, complete blood counts, and complete metabolic panels.
Some of these patients also received more invasive testing including computed tomography, activated charcoal, lumbar punctures, and intravenous antibiotics. All of these contribute to higher hospital and emergency room costs, increased lengths of stay, and potential harm to the patients.
In addition to increased emergency room visits, from to , the call volume at Poison Control Centers for pediatric marijuana exposures had increased by None of these products are required to have safety packaging to prevent accidental ingestion by children. In addition, no warning labels or verification of product ingredients is required, leaving the medical community caught between providing safe medical care and allowing patient autonomy.
As mentioned previously, the AAP has published recommendations to limit the access of marijuana to children. In , amidst medical marijuana legalization in several states, Seamon et al 21 identified that pharmacists needed to be attentive to the legislative changes going on at the state and federal levels. Pharmacists are uniquely poised to understand the medicinal chemistry as well as the practical implications associated with decriminalization and legalization.
Pharmacists can continue to educate both medical professionals and lay people about the differences among cannabinoids, and help to remove the stigma around appropriate and legal use of CBD products. At the same time, medical professionals need to remember the documented deleterious effects of acute marijuana intoxication on neurocognitive development and psychiatric issues. Many health care facilities are working through processes that address patient use of these medications.
Whatever the state and situation, pharmacists need to be aware of the external factors associated with allowing a patient to use CBD in an inpatient setting. Pharmacists are also poised to participate in the design and evaluation of current and future research in this area.
The importance of drug interactions between CBD and other antiepileptics remains uncertain both for the efficacy and safety of CBD products. The difference in concentrations, dosages, and formulations of various products sold at private dispensaries is not standardized or regulated. Differences in state legislation on allowable concentrations and amounts can be confusing for patients and their families, and pharmacists can help to provide that information. Various organizations have been helpful in updating and summarizing this information.
Cannabis and its ingredients have had a fascinating history over the past years, but lack of published data precludes fully recommending its use for medicinal purposes in pediatrics.
Further study is underway and will add to our knowledge of the efficacy and safety of CBD in pediatrics. Long-term studies to assess neurocognitive development with CBD will need to be assessed as well. As pharmacists, it is our duty to provide our patients and their parents with the most accurate, safe, and legally appropriate advice. Disclosures The authors declare no conflicts or financial interest in any product or service mentioned in the manuscript, including grants, equipment, medications, employment, gifts, and honoraria.
Of note, both Augusta University ClinicalTrials. National Center for Biotechnology Information , U. J Pediatr Pharmacol Ther. Author information Copyright and License information Disclaimer. Abstract Despite its controversial nature, the use of medical marijuana and cannabis-derived medicinal products grows more popular with each passing year. CBD, cannabidiol; cannabis; epilepsy; pediatrics; pharmacy. Introduction Over the past several years, medical marijuana use has become a controversial topic not only within the medical community but also at state and national legislative levels.
History and Regulation Dating back as far as BC, hemp plants had been used for various medicinal and industrial purposes. Open in a separate window. Pharmacology Similar to endogenous opioids, a human's central nervous system is impregnated with cannabinoid receptors and endocannabinoids. Pharmacokinetics Historically, patients and recreational users have inhaled or vaporized marijuana, resulting in a quick onset and higher peak concentrations.
Clinical Data The debate about the use of cannabinoid products in pediatric patients has persisted owing to the lack of well-developed and published randomized controlled trials.
Pharmacist's Role In , amidst medical marijuana legalization in several states, Seamon et al 21 identified that pharmacists needed to be attentive to the legislative changes going on at the state and federal levels.
Conclusions Cannabis and its ingredients have had a fascinating history over the past years, but lack of published data precludes fully recommending its use for medicinal purposes in pediatrics. Footnotes Disclosures The authors declare no conflicts or financial interest in any product or service mentioned in the manuscript, including grants, equipment, medications, employment, gifts, and honoraria.
Cited June 8, Accessed March 19, University of Washington; Updated June The pharmacologic and clinical effects of medical cannabis. Persistent cannabis users show neuropsychological decline from childhood to midlife. Comprehensive review of medicinal marijuana, cannabinoids, and therapeutic implications in medicine and headache: Friedman D, Devinsky O. Cannabinoids in the treatment of epilepsy. N Engl J Med. Updated October 24, Cited January 27, American Academy of Pediatrics; American Academy of Pediatrics reaffirms opposition to legalizing marijuana for recreational or medical use.
Updated January 26,
Is CBD Oil Safe for Kids?
Some parents are using CBD oil to treat seizures, pain, and even autism in their kids. Before you try it, learn the facts. It is cannabis oil -- also known as CBD oil -- and Aran says it has a profound The idea of treating autism with cannabis oil was not Aran's idea; it came from his patients. Desperate pleas from parents who lived in fear of their children's unpredictable, uncontrollable and often violent autistic outbursts. What Parents Should Know About Kids Using CBD cbd oil tincture High levels of CBD and low levels of THC are found in most medical It provides patients with a concentrated dose of CBD to treat seizures in rare forms of epilepsy. . If you have a specific question, please contact a Parent Specialist.